Age and HBsAg level predict NA-induced HBeAg seroconversion durability

By Lucy Piper, Senior medwireNews Reporter

The combination of age and baseline hepatitis B s-antigen (HBsAg) level can help predict hepatitis B virus (HBV) relapse in patients who achieve hepatitis B e-antigen (HBeAg) loss or seroconversion following nucleos(t)ide analogue (NA) treatment, researchers report.

They found that being 40 years of age or older and having baseline HBsAg levels of 2000 IU/mL or above both significantly and independently predicted HBV relapse during up to 5 years of treatment.

And having both factors predicted the highest rates of relapse, increasing the risk 13.49-fold compared with patients meeting neither of the criteria. Patients with both risk factors were additionally a significant 2.22-fold more likely to relapse than patients who were aged 40 years or older but had HBsAg levels below 2000 IU/mL.

“These findings indicate that an older age (≥40 years) may be typical of a poor immune response in terms of HBV DNA suppression in patients with NA-induced or spontaneous HBeAg seroconversion”, the team writes in the Journal of Gastroenterology and Hepatology.

The 157 study participants, who were previously NA-naïve and had no signs of cirrhosis or hepatocellular carcinoma, were treated with lamivudine, entecavir or telbivudine. All achieved HBeAg loss or seroconversion and treatment was stopped when undetectable HBV DNA levels were documented on two separate occasions at least 12 months apart.

Eighty-two of the patients relapsed over the 5-year post-treatment follow-up. The mean time to HBV relapse after NA cessation was 13.9 months and 69.5% of patients relapsed in the year after stopping NA treatment.

The rate of relapse at 5 years was significantly higher among patients aged at least 40 years than among those younger than 30 years old and those aged 30 to 39 years, at 84% versus 34.4% and 48.4%, respectively.

Also, based on baseline HBsAg levels, cumulative relapse rates at 4 years were significantly higher for those with levels of at least 2000 IU/mL, at 62.8% compared with 33.7% for those with lower levels.

Researcher Chien-Hung Chen (Kaohsiung Chang Gung Memorial Hospital, Taiwan) and colleagues caution against stopping NA treatment in patients with these risk factors, however, having found that “approximately 90% of such patients experienced a post-treatment HBV relapse within 3 years off-treatment.” Rather, they recommend closely monitoring HBV relapse after NA cessation in these patients.

Despite previous evidence showing that prolonged consolidation therapy of more than 18 or 24 months protects against HBV relapse, there was no evidence of this in the current study. And there was no significant difference in post-treatment HBV relapse rates between patients taking entecavir and those taking lamivudine.

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